Kidney Disease in America: A Closer Look at this Silent Epidemic By Kathleen Murphy, CCHT
Updated: Sep 5, 2019
“And then he asked me to marry him. Isn’t it beautiful?” I looked down at the engagement ring with a smile and nodded in agreement with 21-year-old Stephanie* (name has been changed). Soon the machine was beeping that it was done with a test cycle, and I began to chart treatment notes. “He can’t come in here though. He knows about my condition, but it’s just too much for him. Know what I mean?” Stephanie looked up at me wistfully. I asked what exactly her fiancé considered ‘to much’, to which she responded, “its to much for him to sit in the clinic with me and know if I don’t do this at least three times a week, I’ll die.” What Stephanie was referring to in that moment was her battle with End Stage Renal Disease, or ESRD. ESRD is often known simply as ‘kidney disease’, which is a disease currently effecting nearly 40 million Americans. ESRD is a healthcare crisis that continues to grow, and with so many Americans suffering from this condition, it is disheartening that the consequences of kidney disease as well as warning signs, are not more well known to the general public. As with any issue, the ever-increasing epidemic will continue to claim the lives of millions of Americans, until it is acknowledged by both healthcare professionals and the public. This article will address what kidney disease is, what treatment options are currently available, what we as Americans can be doing better, and how to implement a viable plan that will increase the likelihood of preventing this disease from claiming more lives.
One of the barriers to preventing kidney disease is that most people do not understand what the functions of their kidneys are, and what the physical consequences are that may occur during kidney failure. In short, when someone has one or two kidneys functioning at 15% or less, then that person will be diagnosed with End Stage Renal Disease. Most people are born with two kidneys, but one functioning kidney is adequate in an average healthy individual. Kidney’s do more than just clean blood, although that is a big part of their job. The America Kidney Fund shares a list of other functions of the kidneys, including: filter waste and extra water out of your blood through the process of making urine, control appropriate chemical and fluid levels in your body, work to promote a healthy blood pressure (which is also very important for heart health), keep bones healthy, and produce new Red Blood Cells. The kidneys are very small yet do so much work to maintain a healthy body. Thus, the consequences of kidney failure are that the individual is at risk for multiple diseases, infections, hospitalization, or even death.
Now that a general explanation of what kidneys are and what they do has been given, some other frequently asked questions or generally misunderstood concepts will be addressed. One highly common misunderstanding I have run across often in my work, is the idea that only certain people will get kidney disease. In truth, ESRD does not discriminate on age, race, or gender. That is, some people are more susceptible due to genetics, or due to other current diseases they are already experiencing, but any human at any age can potentially experience kidney disease. I personally have found that outside dialysis clinic walls, many people think kidney disease is something only elderly people face. Nothing could be further from the truth. I have worked with patients on a range from 17 years old – 103 years old, and everything in between.
Another common misconception is that kidneys will heal themselves and start functioning again. Kidney disease does not pass through our bodies the way that kidney stones do. While the body’s self-healing functions may be true in some cases, it is important to consider that there are two types of kidney failure which are ‘acute’ and ‘chronic’. Acute may be temporary kidney failure brought on for several reasons, but chronic is certainly the most common and offers no potential for the kidneys to regain function. Whether chronic or acute, the subtle symptoms of kidney failure are the same. The tricky part is that the early warning signs of ESRD can be dismissed by the person experiencing them as merely consequences of overworking oneself, being overly stressed, or having a common cold or flu like symptoms. The American Kidney Fund shares a list of symptoms one may be experiencing as their kidney failure reaches stage 5, the final stage. It is noted that these symptoms are brought on gradually and someone suffering from the condition will most likely experience one or more of the following: Itching, muscle cramps, nausea and vomiting, loss of appetite, swelling in feet and/or ankles, too much or not enough urine output, trouble catching your breath (due to fluid buildup around lungs), and trouble sleeping. Although not included on the list, it is also common for someone to experience a high fever and/or vomiting, especially if they have not received any treatment for their kidney disease, and toxins and waster are continually building up in their body, endangering their life by each second that passes. It is easy to see how one might explain away these early warning signs, and we as healthcare professionals and educators must be vigilant in raising awareness to the general public and making these signs and symptoms less surprising, and more commonly known.
Now that there has been a general foundation laid explaining how healthy kidneys function, and what signs and symptoms of failing kidneys are, the treatment options available will be discussed. Although several more articles could be (and have been) written to explain in detail how the two options works, I will try to cover much ground in only a few sentences. In short, the two options currently available are getting a kidney transplant, or the more commonly accessible option, that being dialysis. If you are not a celebrity like Selena Gomez or Tracy Morgan, chances are you will not be able to get a kidney transplant immediately. That is, one does not simply sign up for a kidney transplant, but rather must meet certain health criteria and qualifications. That’s right, having an ESRD diagnosis is by no means enough to land you on the transplant list. I have seen patients disqualified for a transplant due to factors such as extreme obesity with no signs of improvement, continued substance abuse including drugs (both prescription and street), and alcohol, and frequently missed or late arrivals to dialysis treatments. If you are extremely blessed and find family members or friends willing to donate, there is still the added challenge that your friend/family member must qualify as a healthy donor, or what we most commonly hear being referred to as “a match”. This can either be a wonderful solution, or a heartbreaking roller coaster of high hopes being dashed by the reality that not everyone is an appropriate match. I have even heard of cases where my patient’s donor was disqualified last minute due to traces of weed found in the donor’s system. Thus, the most viable option for many people is dialysis.
Dialysis is often given in a clinic setting. There are always variations, but the typical dialysis patient will be required to attend treatment 3-4 times a week, for about 3-4 hours per treatment. In order to receive dialysis a patient must have a dialysis port which is often placed in their leg or arm. The most common kinds of ports are either a fistula or a graft. In order to have a fistula, a patient must undergo a type of surgery where the doctor will make a connection with the patient’s artery and vein. This procedure will make a wider “entrance/exit” for the two needles that will be inserted in the patients arm or leg, prior to treatment. The needles must be rather wide, ranging from 17 gages – 15 gages, because their purpose is to connect to the tubes, or “bloodlines” on a dialysis machine. The dialysis machine is what will be cleaning the patient’s blood through a filter, then returning the cleansed blood back into the patient’s body. There are other types of dialysis ports a patient can have in order to create an entrance/exit pathway going from their body, onto a dialysis machine, and (the cleaned blood) back into their body. However, there are few other options, not every option available is appropriate for every patient, and other options (such as a CVC port) will put the patient at higher risk of infection. The key point here is that many patients do not like needles and going to treatment 3-4 times a week is very disruptive in their everyday life. Many of my patients have told me of the difficult challenges their new lifestyle brought on, many concluding with the same sentence “well I guess I don’t have any other options.”
It is important to understand that no one who has kidneys is excluded from the risk of kidney failure. For someone who is currently of average health, the best option is to avoid becoming ill. There will always be exceptions to the rule, as some people acquire ESRD through genetics, or other unavoidable and unfortunate circumstances. However, the general population of Americans would be well advised to start paying quality attention to their current lifestyle habits. I firmly believe there have been patients diagnosed with ESRD who may have been able to avoid this chronic illness had they known the benefits of lifestyle changes before their kidneys failed to a point of no return. It is both healthcare professionals and every individual’s responsibility to become more educated on how to live a healthy lifestyle that will support the health and longevity of kidney function.
We live in an age of technology, with just a few taps on one’s smart phone, a world of information is opened. If a smart phone is not in the budget, there are many libraries or even newspapers with health articles that can be picked up at a local coffee shop. If one is really at a loss for information on how to live a healthy lifestyle, just walk into the nearest hospital or general wellness clinic. There are often free pamphlets explaining how to avoid or manage diabetes, or high blood pressure, which are two of the main causes of kidney failure. End Stage Renal Disease is truly an epidemic in our lifetime. With an increase in education and individuals taking personal steps to improve their lifestyle habits, it is highly probable that the incidences of End Stage Renal Disease will decrease dramatically. Although patient’s on dialysis can still enjoy quality of life, the time commitment, painful needles, constant risk of infection, and hospitalization, have left many of my patients telling me “If I only knew about my lifestyle choices back then, I would not be dealing with this now.” Knowing how to maintain a healthy lifestyle and then implementing that knowledge, is every individual’s responsibility, but it should not be every individual’s solo journey. Both healthcare professionals and laymen need to come together in supporting and educating one another on how to live a healthier lifestyle and avoid the diagnosis of End Stage Renal Disease altogether.
American Kidney Fund. http://www.kidneyfund.org/